Healthcare Provider Details

I. General information

NPI: 1366628679
Provider Name (Legal Business Name): JOHN J COLEMAN DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

159 NORTH 3RD STREET
MACCLENNY FL
32063-2103
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-5277
  • Fax: 904-653-4677
Mailing address:
  • Phone: 904-259-5277
  • Fax: 904-653-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO001570
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN J COLEMAN
Title or Position: PODIATRIST/OWNER
Credential: DPM
Phone: 904-259-5277